What is the role of arthrography in the workup of ulnar-sided wrist pain?

Updated: Nov 22, 2019
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

When imaging examination results suggest a triangular fibrocartilage complex (TFCC) defect or interosseous ligament instability, arthrography may be used to confirm the diagnosis. [35, 36] Contrast material may be injected into one of the three noncommunicating spaces of the carpus: the distal radioulnar joint (DRUJ), the radiocarpal joint, and the midcarpal joint. The decision to obtain a single-injection arthrogram versus a triple-injection arthrogram must be based on specific clinical findings.

At least one third of cadaver dissections have abnormal communications of the wrist joint. Mikic reported that the incidence of degenerative perforations that allow these abnormal communications increases with age. [37] Many of these perforations are asymptomatic.

Magnetic resonance arthrography enhances arthrography and would be the examination of choice for the detection of interosseous and extrinsic ligament tears. However, the value of arthrography has come into question because most findings can be viewed directly with arthroscopy or MRI. In some instances, contrast-enhanced MRI can be used to determine whether a fluid-filled sac communicates with the wrist joint.


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